TriForce Master's Program Registration- EN

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Name *

First Name Last Name

E-mail

example@example.com

Are you new to TriForce? *

Yes, I'm new to the Master's Family No, I'm a returning Master's Warrior No, I'm a returning Master's Warrior but my info has changed

Phone Number *

Area Code Phone Number

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Emergency Contact *

First Name Last Name

Emergency contact phone number *

Area Code Phone Number

Birthday *

Please read the questions carefully and answer each one honestly by checking YES or NO. Questions have been adapted from the CSEP Physical Activity Readiness- Questionnaire (PAR-Q) form.

	YES	NO
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were NOT doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem (ex: back, knee or hip) that could be made worse by a change in your physical activity?
Is your doctor currently prescribing drugs (ex: water pills) for your blood pressure or heart condition?
Do you know of ANY other reason why you should not do physical activity?

Please provide more details for the questions that you answered YES to.

By answering YES to one or more questions, it is recommended that you seek physician approval BEFORE you start becoming more physically active with TriForce.

I will meet with my doctor and obtain his written approval BEFORE starting any program with TriForce. I will NOT meet with my doctor. I agree that my electronic signature below indicates my acceptance of all risks associated with commencing a physical activity regimen without first obtaining the recommended physician clearance.

Please describe, if applicable, any other conditions (such as allergies, asthma), injuries (past and present), medications or surgeries that are not reported above. *

Do you want to pay online or in person? *

Pay Online Pay In Person

2 - Do you want to pay online or in person? *

Pay Online Pay in-person

How many days will you attend for Day 1: Total Body Strength - Tuesdays: Sept 7 -Dec 21 @ 11am - 12pm *

$7.50 each

How many days will you attend for Day 2: Total-body Body Strength - Thursdays: Sept 9 - Dec 23 @ 11am-12pm *

$7.50 each

How many days will you attend for Day 3: Total Body Conditioning & Mobility- Friday: Sep 10 - Dec 24 @ 9 am - 10 am *

$7.50 each

Online Maintenance Fee $4.00 CAD *

$3.00 each

Total Cost

$

You can pay in-person by cash, cheque, debit or credit card. Please allow a few extra minutes before or after your first class for payment or seek Robert/Sue with the total cost above to pay the next time you are at the Center.

How many classes can you come to for the 15-week winter session (45 total classes)? *

Day 1: Total Body Strength - Tuesdays: Sept 7 - Dec 21 @ 11am - 12 pm $ 7.50 CAD

Quantity

Day 2: Total Body Strength - Thursdays: Sept 9 - Dec 23 @ 9am-10am $ 7.50 CAD

Quantity

Day 3: Conditioning & Mobility - Fridays: Sept 10 - Dec 24 @ 9am - 10am $ 7.50 CAD

Quantity

Online Maintenance Fee $ 3.50 CAD

Total $ 0.00 CAD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Signature

Clear

(*After payment there will be no further adjustments to the price or issue of any refunds of any kind for missed classes. You may email an appeal for a "reasonable" extension for any "in-person cancellation" of classes that you paid for, in guidance with unforeseen/foreseen circumstances including weather. Your appeal must be sent within 1 week of the cancellation of that class in question or you forfeit your right for an appeal. All appeals will be reviewed on a case by case basis. There is no guarantee you will be granted an extension despite following the appeal process. Note: Reimbursements will not be offered as stated above, only extensions.)